title: The role of central haemodynamic monitoring in abdominal aortic surgery. A prospective randomised study.
abstract: To test the hypothesis that central haemodynamic monitoring is not necessary in all patients undergoing abdominal aortic surgery, a prospective randomised study in 40 consecutive patients undergoing elective abdominal aortic surgery was carried out. Patients with unstable angina, recent myocardial infarction (less than or equal to 6 months), and left ventricular ejection fraction (LVEF) less than 0.50 were excluded. Twenty-one patients had perioperative central haemodynamic monitoring while 19 patients had central venous pressure monitoring alone. Parameters studied included, perioperative haemodynamics and fluid balance, perioperative cardiac drug administration, operation time and clamp time, postoperative renal function, incidence of postoperative ventilation and line complications, duration of hospital and ICU stay, and 30 day postoperative outcome. Results obtained were compared with a high risk group of patients (LVEF less than 0.50) undergoing similar surgery. Statistical analysis failed to show any difference in outcome for any variable measured in either low risk group. All serious postoperative cardiac complications occurred in patients with LVEF less than 0.50 (P less than 0.0001). These data suggest that patients with LVEF greater than or equal to 0.50 are at low risk of developing postoperative cardiac complications and can be successfully managed perioperatively without the added potential risks and costs of central haemodynamic monitoring.
authors.affiliation: Department of Surgery, Wellesley Hospital Toronto, Ontario, Canada.
authors.forename: W P
authors.initials: WP
authors.lastname: Joyce
authors.forename: J L
authors.initials: JL
authors.lastname: Provan
authors.forename: F M
authors.initials: FM
authors.lastname: Ameli
authors.forename: M M
authors.initials: MM
authors.lastname: McEwan
authors.forename: S
authors.initials: S
authors.lastname: Jelenich
authors.forename: D P
authors.initials: DP
authors.lastname: Jones
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D002405:Catheterization, Central Venous; D002407:Catheterization, Swan-Ganz; D005260:Female; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology